Provider Demographics
NPI:1558881003
Name:GATEWAYS HOSPITAL SOCIAL REHABILITATION PROGRAM
Entity Type:Organization
Organization Name:GATEWAYS HOSPITAL SOCIAL REHABILITATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTARIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRYMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-644-2000
Mailing Address - Street 1:1891 EFFIE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1711
Mailing Address - Country:US
Mailing Address - Phone:323-644-2000
Mailing Address - Fax:323-953-6588
Practice Address - Street 1:423 N HOOVER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-2306
Practice Address - Country:US
Practice Address - Phone:323-644-2000
Practice Address - Fax:323-953-6588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GATEWAYS HOSPITAL AND MENTAL HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness